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MEDICAID INFORMATION RELEASE MA05-41
posted on March 02, 2009 12:18
January 1, 2006
MEDICAID INFORMATION RELEASE MA05-41
TO:
Physicians, Osteopaths, Anesthesiologists, Mid-level Practitioners, Hospitals, and Ambulatory Surgical Centers
FROM:
Leslie M. Clement, Deputy Administrator
SUBJECT:
CHANGES IN PRIOR AUTHORIZATION REQUIREMENTS FOR SPINAL NEUROSTIMULATORS
Effective for dates of service on or after
02/01/2006
, prior authorization will be required for implantation of
spinal
neurostimulators.
This includes all services, supplies, facility, and ancillary charges related to implantation of spinal neurostimulators with the following codes:
·
ICD-9 Procedures and Interventions code 03.93, (
Implantation or replacement of spinal neurostimulator lead(s
), including all services related to inpatient, outpatient, and ambulatory surgical center charges for services.
·
CPT
procedure codes 63650, 63655, 63660, 63685, and 63688
To request prior authorization for implanted
spinal
neurostimulators:
Submit a
Surgery Prior Authorization Request
form, which is available online at:
http://www.healthandwelfare.idaho.gov/DesktopModules/Documents/DocumentsView.aspx?tabID=0&ItemID=4442&MId=11623&wversion=Staging
Follow the procedures in Section 2.3 of the Medicaid provider manual, which is available online at:
http://www.healthandwelfare.idaho.gov/Portals/_Rainbow/Documents/medical/s2_gen_billing.pdf
Include the following documentation when submitting a request for prior authorization:
ð other, less invasive procedures that are contraindicated, or have been attempted without success;
ð client has received a multidisciplinary team screening and evaluation;
ð client has received a psychological evaluation; and
ð when requesting prior authorization for permanent implanted spinal neurostimulators, document that relief of pain has been demonstrated with a temporary implanted electrode(s).
PROVIDER HANDBOOK:
This information release changes information in the following section(s) of the Idaho Medicaid Provider Handbook:
Physician/osteopath handbook
, Section 3.3.3.6, which is available online at:
http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/s3_004_005_physician.pdf
Hospital handbook
, Section 3.4.13 through 3.4.15, which is available online at:
http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/s3_001_hospital.pdf
If you have questions concerning this Information Release, please contact Arla Farmer, Bureau of Medical Care, at (208) 364-1958 or by FAX at (208) 332-7285.
Thank you for your continuing participation in the Medicaid Program.
LC/af
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